The field of the invention is in training of military and civilian medical personnel to provide prompt, effective treatment of emergency injuries and other medical treatment situations. The field of military medical training has expanded due to the increase in use of reserve and National Guard forces that are being deployed on active duty. Although active duty forces can be sent for training to a few central training facilities, reserve and National Guard forces need to stay close to home. The result is a large increase in the number of pre-deployment training facilities and an increase in the need for training aids. In the civilian community, because of homeland security concerns, training readiness through Federal, state and local facilities must be maintained for wounds, for example, blast injuries, which heretofore were relatively rare events. In order to support these facilities, training devices are needed which support training course objectives.
In order to address the need for training devices, attempts have been made to use existing devices from other fields in the military and civilian emergency training field. The results have not met the needs of trainers or trainees in the military and civilian emergency training field.
Weighted training dummies which were used for fire and rescue were tried in the field of military and civilian training. While such dummies were satisfactory to build the physical conditioning for carrying emergency patients or transporting them on litters, they do not meet training needs for realism or supporting medical treatment tasks.
Educational simulation devices were also tried in the field of medical and civilian training. Such simulation devices had been developed for hospitals and medical schools to educate medical students, nurses and other medical personnel how to treat typical medical conditions in hospital and nursing home environments, such as heart attack, insulin over/underdose. Such educational simulation devices are not intended for the military and civilian emergency training field both with respect to realism and ruggedness. Such simulators are tethered to computers through hardwire and datalinks and also, in some cases, tethered to air compressors, making them impossible to meet field environment conditions and to support patient evacuation training. Because such devices were aimed at education, they did not address specific tasks which emergency medical personnel must carry out, such as application of tourniquets. Such simulators are also relatively expensive. There is therefore a need for training simulation method and apparatus to meet the current training needs of, for example, military and civilian personnel.
Emergency medical treatment tasks are commonly defined by military and civilian medical institutions. For example, a task can be an action which a medic or other personnel takes in accordance with military doctrine or civilian medical protocol. The medic must recognize which tasks to perform and how to perform them, based on the stimuli presented by the patient and the situation. Current training devices do not present adequate stimuli to cue medic tasks or provide realistic stimuli associated with medical treatment scenarios. For example, the anthropomorphic simulators which are used in medical schools do not have the capability to adequately support tourniquet application training with regard to simulated skin realism or the amount of pressure required to stop the bleeding. Examples of such tasks may include: (1) Triage Decisions regarding the order of treatment of patients (2) Airway clearing and maintenance by, for example, nasopharyngeal tube, oral tube or cricothryoidectomy, (3) Breathing support including pneumothorax lancing (4) Bleeding cessation by, for example, application of pressure, tourniquet application or use of hemostatic agents, (5) Body fluid balance by, for example, intravenous or intraosseous infusion (6) Patient Assessment for burns, dislocations, etc. (7) Pain Control by providing analgesics, (8) Splinting Fractures detected by crepitus, (8) Antibiotics Administration using and intravenous or intra osseous line and (9) Evacuation Categorization to determine the priorities and order of transport.
It is well established in the biopsychology literature that there are five separate learning systems in the brain which are mediated by separate structures. (Bear et al. 2001, p 740-1). The five systems are (1) factual (2) experiential (3) procedural (4) skeletal muscle coordination and (5) emotional. In medical training, the factual learning system is typically addressed through didactic classroom training and the others may be addressed in practical exercises, sometimes practical field exercises. The factual learning system involves memorization of facts through language and is believed to be principally mediated by the human cortex. The experiential learning system involves remembering events and generalizing to new events and is believed to be principally mediated by the hippocampus. The procedural learning system involves motor learning (e.g. riding a bicycle) and is believed to be principally mediated by the striatum, constituting the subcortical motor structures. The skeletal muscle coordination system involves learning coordination of motor events and is believed to be principally mediated by the cerebellum. The emotional learning system involves association of perceptions to autonomic preparation for action (e.g. fear, arousal) and is believed to be principally mediated by the amygdala. Because they are primitive, emotional reactions to situations can interfere with display of other types of learning, for example, the sight of a traumatic wound can trigger emotions which interfere with the performance of motor skills, motor coordination and recall of facts and previous experience.
Medics, corpsmen and others providing emergency medical care need to learn and perform using all five learning systems in order to be prepared to effectively and efficiently carry out their required tasks. They need to have a high degree of fidelity or realism. For some circumstances, fidelity or realism can be considered “the degree to which a model or simulation reproduces the state and behavior of a real world object or the perception of a real world object, feature, condition, or chosen standard in a measurable or perceivable manner; a measure of the realism of a model or simulation; faithfulness.” (Fidelity Implementation Study Group (Gross, 1999).
Current training devices do not adequately support human neural learning systems, especially in practical exercises or field exercises. Procedural and skeletal muscle coordination cannot currently be fully practiced if the training device does not support the task (e.g. tourniquet application) or if the look-and-feel of the device is not realistic enough. Experiential and emotional learning cannot currently be fully practiced because of limited realism and intrusions on realism such as tethers to electrical or pneumatic systems. Desensitization to trauma situations, wounds and other stimuli are required in order to prepare the trainee for future real situations where hesitation or impairment of motor and coordination skills would result in adverse patient outcomes.